摘要
目的探讨胸腔镜治疗迟发型先天性膈疝的疗效并总结治疗经验。方法回顾性分析2012年10月-2015年2月行胸腔镜膈疝修补术的21例迟发型先天性膈疝患儿临床资料。男9例,女12例;年龄2个月~8岁,中位年龄1岁3个月。其中8例以气促、呼吸困难等症状就诊,13例因其他疾病行胸部X线片检查时发现。左侧膈疝17例,右侧膈疝4例。急诊手术5例,择期手术16例。术中探查无疝囊16例、有疝囊5例,胸骨后疝2例、胸腹裂孔疝19例,膈肌缺损范围3 cm×2 cm^5 cm×5 cm。结果手术时间35~80 min,平均50 min;术中出血量3~5 m L,平均3.8 m L。术后切口均Ⅰ期愈合。术后12例患儿出现不同程度腹胀,2例发生气胸。21例患儿均获随访,随访时间1~3年,平均20个月。患儿均恢复良好,胸廓切口外观满意,气促、呼吸困难症状、体征均消失,未见复发、胸腔感染等并发症。结论在严格掌握手术指征下,胸腔镜治疗迟发型先天性膈疝安全、可行。术中应用疝修补针及推结器辅助、合理处理缺损边缘等手术操作细节,能够降低手术难度,减少术后复发率。
Objective To explore the effectiveness ofthoracoscopic surgery for treating late-presenting congenital diaphragmatic hernias and summarize the experience. Methods Between October 2012 and February 2015, 21 children with late-presenting congenital diaphragmatic hernias underwent thoracoscopic surgery. Of the 21 cases, 12 were girls and 9 were boys with a median age of I year and 3 months （range, 2 months to 8 years）. Eight patients had obvious symptom in the initial stage： shortness of breath and dyspnea; 13 cases were found occasionally through chest radiography. Of 21 cases, 17 had left diaphragmatic hernias and 4 had right diaphragmatic hernias. The emergency surgery was performed in 5 cases because oppressed obviously and selective operation in 16 cases. Hernial sac existed in 5 cases; there were 19 cases of Bochdalek＇s hernia and 2 cases of Morgagni＇s hernia. The size of diaphragmatic defect ranged from 3 crux2 cm to 5 crux5 cm. Results The operation time was 35-80 minutes （mean, 50 minutes）, and intraoperative blood loss was 3-5 mL （mean, 3.8 mL）. Primary healing of incision was obtained. Postoperative abdominal distension and pneumothorax occurred in 12 and 2 cases respectively. The follow-up time was 1-3 years （mean, 20 months）. All the cases had a good recovery and satisfactory appearance of the thoracic incision. The symptoms and signs of shortness of breath and dyspnea disappeared. There was no recurrence and chest infection. Conclusion Under the conditions of mastering operative indications strictly, thoracoscopic repair for late-presenting congenital diaphragmatic hernia is safe and feasible. It can facilitate the procedure and decrease the recurrence rate relying on intraoperative application of hernia repair needle, knot pusher-assistant, and reasonable processing defect periphery.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2016年第5期590-593,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金青年基金资助项目(31201095)~~
关键词
迟发型
先天性膈疝
儿童
胸腔镜
微创手术
Late-presenting congenital diaphragmatic hernia
Thoracoscopy
Minimally invasive surgery
Children
